| [ Summary ] |
We reported that selective PEIT in parathyroid glands, guided by color Doppler flow mapping, is effective for severe secondary hyperparathyroidism (2°HPT) in chronic dialysis patients. PEIT has become an adjunct to medical therapy. However, PEIT has some risks of side effects, such as recurrent nerve palsy. In this study, we examined whether it was possible to control parathyroid function with this therapy and to determine the cause of this parathyroid disfunction. We injected 100% of the calculated gland volume of calcitriol solution (2microg/ml) into the glands of 24 patients, instead of ethanol (percutaneous calcitriol injection therapy: P-CIT). The intact parathyroid hormone (i-PTH) levels decreased significantly after four weeks. Following one further year of calcitriol pulse therapy, PTH levels remained suppressed. Serum alkaline phosphatase activity and the volume of the parathyroid glands also decreased. During a long term follow up, eighteen patient's levels remained well controlled with calcitriol pulse therapy, while six patients needed PTx or PEIT. Pathologically, more fibrosis was seen in PTG after P-CIT. Our data support that the injection of P-CIT into the parathyroid glands may be another treatment option for chronic dialysis patients. |